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SOHO 2020: Bringing 'MPN Awareness' to Hematology Community

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The Eighth Annual Society of Hematologic Oncology (SOHO 2020) joined the pantheon of 2020 medical meetings that went virtual due to the COVID-19 pandemic and made great use of the opportunity to broaden participation globally via an online format. I love attending the SOHO meetings and have attended them since their inception. Although usually a little warm (September in Texas!), the meeting is a great way to connect with key leaders across hematologic malignancies and walk away fully informed on the state of the art practices in leukemias, lymphomas, and myeloma. This year’s virtual SOHO did not disappoint and did a marvelous job sharing the advances in combating myeloproliferative neoplasms (MPNs).

International MPN Awareness Day was September 10th, 2020, and nicely this same day contained the main thrust of the SOHO sessions on MPNs. Indeed, SOHO has become a key venue for connecting on MPNS with multiple great didactic lectures (Dr’s S. Verstovek, U. Popat, L. Michaelis), an independent satellite symposium on new therapies in MPNs (in which Dr’s P. Bose, R. Rampal, and I participated), and 29 abstracts! SOHO helped make it clear there is great progress in the management of MPNs, and that the pipeline of new therapies is robust!

  • INTERFERONS: Highlighting some key themes, I would first want to focus on the increasingly important role of long-acting interferons and how they might alter the treatment of essential thrombocythemia (ET) and polycythemia vera (PV). The provocative findings, presented at EHA 2020 by Prof Barbui, showed the superior benefits of Pegylated Interferon Alpha 2b (besremi, AOP Pharma Austria) vs. phlebotomy alone in low-risk PV for events and impact on PV symptoms and quality of life. These latter findings may well impact the traditional approach of solely aspirin and phlebotomy in low-risk PV.
  • FEDRATINIB in MF: Fedratinib is a key treatment option for patients with myelofibrosis in both the front- and second-line settings. I presented, on behalf of many colleagues, an updated analysis of the JAKARTA study (FEDR vs placebo in front line) and JAKARTA2 study (single arm FEDR second line). Amongst those patients who received six cycles, 76% (51/67) of fedratinib-treated patients achieved a spleen volume (n=40 [60%]) or symptom (n=35 [52%]) response, including 24 patients (36%) who achieved both responses. In JAKARTA2, 81% of patients (34/42) achieved a spleen volume response (n=24 [57%]) or a symptom response (n=20 [48%]), including 10 patients (24%) who achieved both. These results continue to highlight the efficacy of FEDR in MF and consideration for use in both front- and second-line settings. 
  • JAK Inhibitor Pipeline: The JAK inhibitor pipeline is robust. There were significant discussions on both of the ongoing studies Momentum (Momelotinib: JAK1, JAK2, ACVR1 inhibitor- Sierra Oncology) and PACIFICA (Pacritinib; JAK2 and FLT3 inhibitor- CTI Biopharma). Abstracts regarding momelotinib detailed the ability to maintain dose intensity, safety, and impact on anemia by a time-to-event transfusion analysis, emphasizing momelotinib’s benefit on anemia due to its impact on decreasing pathological levels of hepcidin through ACVR1 inhibition. These two agents, if successfully approved, could impact front- and second-line therapy of MF for those with anemia (momelotinib) and/or thrombocytopenia (pacritinib).
  • New Targets: MPN therapies are moving beyond JAK inhibition. Evolving data from ongoing trials of adding a second agent to a JAK inhibitor base (i.e. in patients having a suboptimal response) look promising for anemia (TGF-beta ligand trap, luspatercept; BMS) and a range of suboptimal ruxolitinib responses (bcl-2 inhibitor navitoclax; Abbvie and CPI-0610- BET inhibitor; Constellation Pharmaceuticals). All of these trials look promising for new options for MF patients, with even exploration of impacting front-line (CPI-0610 and ruxolitinib in the Manifest Trials.

The virtual Eighth SOHO Conference did not disappoint, was well organized, and brought the world together to celebrate advances in caring for hematological malignancies! MPN Awareness is strong, with a robust pipeline offering hope for many additional treatment options for treating physicians to select and MPN patients to benefit from in the near future.

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